The Management of Q-Wave Versus Non-Q-Wave Infarction
For some time, myocardial infarction has by convention been referred to as subendocardial (nontransmural) or transmural infarction. This is an electrocardiographs classification in which patients with an infarction accompanied by Q-waves on the electrocardiogram are said to have a transmural and those without a Q-wave a subendocardial, or nontransmural, infarction. Despite being an electrocardiographs classification, it has pathological implications (1). Experimental and clinical data do not show a consistent relationship between transmural myocardial injury and the development of Q-waves or vice versa (2). However, patients with infarction manifesting only ST-T changes have less extensive damage (infarct size). Thus, it has been suggested to classify infarction as Q-wave infarction (transmural) or non-Q-wave (nontransmural). Myocardial infarction occurring in association with new Q-waves of 30 msec duration or greater is referred to as Q-wave infarction. Myocardial infarction associated with ST-T changes without the development of new Q-waves will be referred to as non-Q-wave infarction. Patients with previous Q-wave infarction developing new changes but restricted to those leads with previous Q-waves will be classified as indeterminate. However, if the new changes are in leads other than those associated with previous Q-waves, the above classification would be appropriate.
KeywordsCreatine Kinase Infarct Size Creatine Kinase Activity Coronary Care Unit Plasma Creatine Kinase
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